Parkland Health Hospital System

Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details

Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details

Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details

Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details

Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details

Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details